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1.
Radiology ; 307(1): e221263, 2023 04.
Article in English | MEDLINE | ID: mdl-36511806

ABSTRACT

The U.S. National Council on Radiation Protection and Measurements (NCRP) conducted a retrospective assessment of the U.S. data, and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) performed a similar worldwide assessment for 2009-2018 (with most data from 2014 to 2017). Using the data from those reports, the frequency of radiologic and nuclear medicine studies, annual collective, and per capita effective dose in the United States for 2016 were compared with worldwide estimates from 2009 to 2018. There were an estimated 691 million radiologic, CT, dental, and nuclear medicine studies performed in the United States in 2016, which represented 16.5% of the 4.2 billion performed worldwide. The United States also accounted for 74 million CT procedures (18% of the world's estimated total), 275 million conventional radiology procedures (11% of the world's total), 8.1 million interventional radiologic procedures (34% of the world's total), 320 million dental radiography procedures (29% of the world's total), and 13.5 million nuclear medicine procedures (34% of the world's total). The U.S. collective effective dose was 717 000 person-sieverts (17.6% of the world's total). The average annual individual effective dose in the United States was 2.2 mSv compared with 0.56 mSv worldwide. The United States accounts for a large and disproportionate share of global medical radiation procedures and collective effective dose, but use of CT has increased more in other countries compared with the United States.


Subject(s)
Nuclear Medicine , Radiation Injuries , Humans , United States , Radiation Dosage , Retrospective Studies , Radiography
2.
Radiology ; 295(2): 418-427, 2020 05.
Article in English | MEDLINE | ID: mdl-32181730

ABSTRACT

Background Comprehensive assessments of the frequency and associated doses from radiologic and nuclear medicine procedures are rarely conducted. The use of these procedures and the population-based radiation dose increased remarkably from 1980 to 2006. Purpose To determine the change in per capita radiation exposure in the United States from 2006 to 2016. Materials and Methods The U.S. National Council on Radiation Protection and Measurements conducted a retrospective assessment for 2016 and compared the results to previously published data for the year 2006. Effective dose values for procedures were obtained from the literature, and frequency data were obtained from commercial, governmental, and professional society data. Results In the United States in 2006, an estimated 377 million diagnostic and interventional radiologic examinations were performed. This value remained essentially the same for 2016 even though the U.S. population had increased by about 24 million people. The number of CT scans performed increased from 67 million to 84 million, but the number of other procedures (eg, diagnostic fluoroscopy) and nuclear medicine procedures decreased from 17 million to 13.5 million. The number of dental radiographic and dental CT examinations performed was estimated to be about 320 million in 2016. Using the tissue-weighting factors from Publication 60 of the International Commission on Radiological Protection, the U.S. annual individual (per capita) effective dose from diagnostic and interventional medical procedures was estimated to have been 2.9 mSv in 2006 and 2.3 mSv in 2016, with the collective doses being 885 000 and 755 000 person-sievert, respectively. Conclusion The trend from 1980 to 2006 of increasing dose from medical radiation has reversed. Estimated 2016 total collective effective dose and radiation dose per capita dose are lower than in 2006. © RSNA, 2020 See also the editorial by Einstein in this issue.


Subject(s)
Diagnostic Imaging , Nuclear Medicine/statistics & numerical data , Radiation Exposure/statistics & numerical data , Radiometry/statistics & numerical data , Body Burden , Fluoroscopy , Humans , Organs at Risk/radiation effects , Radiation Dosage , Radiography, Interventional , Retrospective Studies , Tomography, X-Ray Computed , United States
5.
Ann Emerg Med ; 63(1): 25-32, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24134958

ABSTRACT

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.


Subject(s)
Emergency Service, Hospital/standards , Practice Guidelines as Topic , Tomography, X-Ray Computed/standards , Brain Injuries/diagnostic imaging , Defensive Medicine/standards , Emergency Service, Hospital/statistics & numerical data , Humans , Tomography, X-Ray Computed/adverse effects , Tomography, X-Ray Computed/statistics & numerical data , United States
6.
J Radiol Prot ; 33(4): 869-80, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24190873

ABSTRACT

Two longitudinal cohort studies of Japanese atomic bomb survivors-the life span study (LSS) and the adult health study (AHS)-from the Radiation Effects Research Foundation (RERF) indicate that total body irradiation doses less than 1 Gy are associated with an increased risk of cardiovascular disease (CVD), but several questions about this association remain.In particular, the diversity of heart disease subtypes and the high prevalence of other risk factors complicate the estimates of radiation effects. Subtype-specific analyses with more reliable diagnostic criteria and measurement techniques are needed. The radiation effects on CVD risk are probably tissue-reaction (deterministic) effects, so the dose-response relationships for various subtypes of CVD may be nonlinear and therefore should be explored with several types of statistical models.Subpopulations at high risk need to be identified because effects at lower radiation doses may occur primarily in these susceptible subpopulations. Whether other CVD risk factors modify radiation effects also needs to be determined. Finally, background rates for various subtypes of CVD have historically differed substantially between Japanese and Western populations, so the generalisability to other populations needs to be examined.Cardiovascular disease mechanisms and manifestations may differ between high-dose local irradiation and low-dose total body irradiation (TBI)-microvascular damage and altered metabolism from low-dose TBI, but coronary artery atherosclerosis and thrombotic myocardial infarcts at high localised doses. For TBI, doses to organs other than the heart may be important in pathogenesis of CVD, so data on renal and liver disorders, plaque instability, microvascular damage, metabolic disorders, hypertension and various CVD biomarkers and risk factors are needed. Epidemiological, clinical and experimental studies at doses of less than 1 Gy are necessary to clarify the effects of radiation on CVD risk.


Subject(s)
Cardiovascular Diseases/mortality , Nuclear Weapons/statistics & numerical data , Radiation Injuries/mortality , Radiation Monitoring/statistics & numerical data , Whole-Body Counting/statistics & numerical data , Adult , Body Burden , Humans , Incidence , Japan/epidemiology , Radiation Dosage , Risk Factors , Survival Rate , Survivors
7.
Birth Defects Res ; 115(14): 1304-1314, 2023 08 15.
Article in English | MEDLINE | ID: mdl-37565260

ABSTRACT

This a historical review and current information regarding risks and effects of ionizing radiation in the context of human pregnancy and in particular the information needed for pregnant women to understand the type and magnitude of risks placing them in a realistic context. Much of our understanding comes from early animal studies but has been supported by studies of human exposure to medical radiation, radiation accidents and nuclear weapons.


Subject(s)
Lactation , Radioactive Hazard Release , Animals , Humans , Female , Pregnancy
8.
J Radiol Prot ; 32(1): N9-N13, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22395124

ABSTRACT

Effects and risk from exposure to ionising radiation depend upon the absorbed dose, dose rate, quality of radiation, specifics of the tissue irradiated and other factors such as the age of the individual. Effects may be apparent almost immediately or may take decades to be manifest. Cancer is the most important stochastic effect at absorbed doses of less than 1 Gy. The risk of cancer induction varies widely across different tissues; however, the risk of fatal radiation-induced cancer for a general population following chronic exposure is about 5% Sv(-1). Quantification of cancer risk at doses of less than 0.1 Gy remains problematic. Hereditary risks from irradiation that might result in effects to offspring of humans appear to be much lower and any such potential risks can only be estimated from animal models. At high doses (over 1 Gy) cell killing and modification causes deterministic effects such as skin burns, and bone marrow depression, in which case immunosuppression becomes a critical issue. Acute whole body penetrating gamma irradiation at doses in excess of 2 Gy results in varying degrees of acute radiation sickness and doses over 10 Gy are usually lethal as a result of combined organ injury.


Subject(s)
Acute Radiation Syndrome/epidemiology , Body Burden , Environmental Exposure/statistics & numerical data , Neoplasms, Radiation-Induced/epidemiology , Proportional Hazards Models , Whole-Body Counting/statistics & numerical data , Whole-Body Irradiation/statistics & numerical data , Humans , Prevalence , Risk Assessment , Risk Factors
9.
Radiology ; 258(1): 236-42, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20971777

ABSTRACT

The average medical radiation effective dose to the U.S. population in 2006 was estimated at approximately 3.0 mSv, an increase of 600% in a single generation. Computed tomography (CT) alone accounts for approximately half of this medical radiation dose. Ongoing advances suggest that CT will continue to be the most important contributor, by far, to medical doses in the United States. The use of ionizing radiation in medical imaging, including CT, provides valuable diagnostic information that undoubtedly benefits many patients. Exposure to radiation, however, is currently believed to carry a small, but nonzero, risk. Accordingly, the medical imaging community must ensure that the benefits of a radiologic examination in any given patient exceed the corresponding risks. It is also the responsibility of the radiologist to ensure that no more radiation is used than needed for obtaining diagnostic information in any radiologic examination, especially CT.


Subject(s)
Cone-Beam Computed Tomography/methods , Radiation Dosage , Radiation Monitoring/methods , Age Factors , Body Size , Humans , Phantoms, Imaging , Risk Assessment , Risk Factors , United States
10.
Radiology ; 258(3): 889-905, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21163918

ABSTRACT

This special report aims to inform the medical community about the many challenges involved in managing radiation exposure in a way that maximizes the benefit-risk ratio. The report discusses the state of current knowledge and key questions in regard to sources of medical imaging radiation exposure, radiation risk estimation, dose reduction strategies, and regulatory options.


Subject(s)
Diagnostic Imaging/adverse effects , Radiation Injuries/prevention & control , Fluoroscopy/adverse effects , Humans , Neoplasms, Radiation-Induced/prevention & control , Radiation Dosage , Radiation Protection , Radiography, Interventional/adverse effects , Risk Assessment , Risk Factors , Sex Factors
11.
AJR Am J Roentgenol ; 196(3): 616-8, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21343505

ABSTRACT

OBJECTIVE: Medical radiation exposure has increased sixfold since 1980 and is the largest controllable source of exposure. Many efforts have been devoted to reducing dose or eliminating unnecessary examinations but with limited success. The concern regarding nuclear terrorism has focused a large amount of attention on radioprotective drugs. The purpose of this article is twofold: to review the current concepts, potential, and limitations of chemical radioprotectants in reducing stochastic and deterministic effects and to assess the potential application to diagnostic and interventional medical radiation procedures. CONCLUSION: There are a wide variety of chemical compounds that have been studied for radioprotective effects. Although there is promising research, chemical radioprotectants have not been shown to be very effective and, with one limited exception, are not the standard of care in medicine.


Subject(s)
Diagnostic Imaging , Radiation-Protective Agents/therapeutic use , Amifostine/therapeutic use , Humans , Radiation Protection/methods , Risk , United States , United States Food and Drug Administration
12.
Health Phys ; 118(4): 335-348, 2020 04.
Article in English | MEDLINE | ID: mdl-32118678

ABSTRACT

The National Council on Radiation Protection and Measurements (NCRP) held its 55 Annual Meeting 1-2 April 2019 in Bethesda, Maryland. The 2019 meeting was a special year for NCRP as it marked the 90 Anniversary of the founding of the predecessor organization, US Advisory Committee on X-Ray and Radium Protection. Leaders for the scientific portion of the meeting were Fred A. Mettler, Jr., M.D. (Chair), University of New Mexico School of Medicine; Jerrold T. Bushberg, Ph.D. (Co-Chair), University of California Davis; and Richard J. Vetter, Ph.D. (Co-Chair), Mayo Clinic. The meeting was designed to explore important areas of inquiry associated with use of ionizing radiation relevant to radiation protection, addressing frequently asked questions and concerns from both members of the public and radiation professionals. The meeting was organized into six sessions plus three honorary lectures and a special presentation. This paper summarizes the scientific content of the six sessions and is based on the notes of the co-chairs and the slides of the speakers. The three honorary lectures are included as other papers in this issue.


Subject(s)
Radiation Monitoring , Radiation Protection , Societies, Scientific , Extraterrestrial Environment , Humans , Radiation Dosage , Radioactive Waste , Risk
13.
Br J Radiol ; 93(1112): 20200282, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32496817

ABSTRACT

Within a few months of discovery, X-rays were being used worldwide for diagnosis and within a year or two for therapy. It became clear very quickly that while there were immense benefits, there were significant associated hazards, not only for the patients, but also for the operators of the equipment. Simple radiation protection measures were implemented within a decade or two and radiation protection for physicians and other operators has continued to evolve over the last century driven by cycles of widening uses, new technologies, realization of previously unidentified effects, development of recommendations and regulations, along with the rise of related societies and professional organizations. Today, the continue acceleration of medical radiation uses in diagnostic imaging and in therapeutic modalities not imagined at the turn of this century, such as positron emission tomography, calls for constant vigilance and flexibility to provide adequate protection for the growing numbers of medical radiation workers.


Subject(s)
Health Personnel , Occupational Exposure/prevention & control , Radiation Protection/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans
14.
J Am Coll Radiol ; 17(9): 1176-1182, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32105647

ABSTRACT

The National Council on Radiation Protection and Measurements (NCRP) recently assessed patient radiation exposure in the United States, which was summarized in its 2019 NCRP Report No. 184. This work involved an estimation of the number of medical procedures using ionizing radiation, as well as the associated effective doses from these procedures. The NCRP Report No. 184 committee elected to not incorporate radiation dose from radiotherapy into its calculated population dose exposures, as the assessment of effective dose for the population undergoing radiotherapy is more complex than that for other medical radiation exposures. However, the aim of NCRP Report No. 184 was to raise awareness of ancillary radiation exposures to patients undergoing radiotherapy. Overall, it was estimated that annually, in 2016, approximately 800,000 patients received approximately 1 million courses of radiation therapy. Each of these treatments includes various types of imaging that may not be familiar to radiologists or others. Exposures from radiotherapy planning and delivery are reviewed in the report and summarized in this executive summary. The imaging techniques, use of this imaging, and associated tissue doses are described. Imaging can contribute a few percent to the planned treatment doses (which are prescribed to specified target volumes) as well as exposing patients to radiation outside of the target volume (in the imaging field of view).


Subject(s)
Radiation Exposure , Radiation Oncology , Radiation Protection , Diagnostic Imaging , Humans , Research Report , United States
15.
Radiology ; 253(2): 520-31, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19789227

ABSTRACT

The U.S. National Council on Radiation Protection and Measurements and United Nations Scientific Committee on Effects of Atomic Radiation each conducted respective assessments of all radiation sources in the United States and worldwide. The goal of this article is to summarize and combine the results of these two publicly available surveys and to compare the results with historical information. In the United States in 2006, about 377 million diagnostic and interventional radiologic examinations and 18 million nuclear medicine examinations were performed. The United States accounts for about 12% of radiologic procedures and about one-half of nuclear medicine procedures performed worldwide. In the United States, the frequency of diagnostic radiologic examinations has increased almost 10-fold (1950-2006). The U.S. per-capita annual effective dose from medical procedures has increased about sixfold (0.5 mSv [1980] to 3.0 mSv [2006]). Worldwide estimates for 2000-2007 indicate that 3.6 billion medical procedures with ionizing radiation (3.1 billion diagnostic radiologic, 0.5 billion dental, and 37 million nuclear medicine examinations) are performed annually. Worldwide, the average annual per-capita effective dose from medicine (about 0.6 mSv of the total 3.0 mSv received from all sources) has approximately doubled in the past 10-15 years.


Subject(s)
Diagnostic Imaging/statistics & numerical data , Nuclear Medicine/statistics & numerical data , Radiation Dosage , Radiology/statistics & numerical data , Diagnostic Imaging/trends , Humans , Internationality , United States
16.
Health Phys ; 116(2): 126-128, 2019 02.
Article in English | MEDLINE | ID: mdl-30585951

ABSTRACT

The use of radiation in medicine and the associated population dose grew very rapidly from 1980-2006 predominantly as a result of computed tomography and nuclear medicine. Over the last decade there have been significant changes in image detectors and processing with almost complete elimination of film use. Economic and reimbursement issues have also had a significant effect on usage. After about 2010, the volume of computed tomography and interventional techniques has been fairly level, plain radiography has declined slightly, and noninterventional fluoroscopy has declined dramatically. Nuclear medicine procedures have also declined significantly. Cone-beam computed tomography has expanded particularly in dental radiography. The use of several complex types of image-guided radiotherapy has increased significantly. National Council on Radiation Protection and Measurements' Scientific Committee 4-9 is currently conducting a full assessment for 2016 of collective and per caput effective dose. The report is expected to be completed in 2019, and preliminary work suggests a decrease in collective and per caput effective dose from that previously estimated for 2006.


Subject(s)
Radiation Exposure/statistics & numerical data , Cone-Beam Computed Tomography/statistics & numerical data , Humans , Radiography/statistics & numerical data , Tomography, X-Ray Computed/statistics & numerical data , United States
17.
Health Phys ; 116(2): 235-246, 2019 02.
Article in English | MEDLINE | ID: mdl-30585971

ABSTRACT

National Council on Radiation Protection and Measurements Commentary 27 examines recent epidemiologic data primarily from low-dose or low dose-rate studies of low linear-energy-transfer radiation and cancer to assess whether they support the linear no-threshold model as used in radiation protection. The commentary provides a critical review of low-dose or low dose-rate studies, most published within the last 10 y, that are applicable to current occupational, environmental, and medical radiation exposures. The strengths and weaknesses of the epidemiologic methods, dosimetry assessments, and statistical modeling of 29 epidemiologic studies of total solid cancer, leukemia, breast cancer, and thyroid cancer, as well as heritable effects and a few nonmalignant conditions, were evaluated. An appraisal of the degree to which the low-dose or low dose-rate studies supported a linear no-threshold model for radiation protection or on the contrary, demonstrated sufficient evidence that the linear no-threshold model is inappropriate for the purposes of radiation protection was also included. The review found that many, though not all, studies of solid cancer supported the continued use of the linear no-threshold model in radiation protection. Evaluations of the principal studies of leukemia and low-dose or low dose-rate radiation exposure also lent support for the linear no-threshold model as used in protection. Ischemic heart disease, a major type of cardiovascular disease, was examined briefly, but the results of recent studies were considered too weak or inconsistent to allow firm conclusions regarding support of the linear no-threshold model. It is acknowledged that the possible risks from very low doses of low linear-energy-transfer radiation are small and uncertain and that it may never be possible to prove or disprove the validity of the linear no-threshold assumption by epidemiologic means. Nonetheless, the preponderance of recent epidemiologic data on solid cancer is supportive of the continued use of the linear no-threshold model for the purposes of radiation protection. This conclusion is in accord with judgments by other national and international scientific committees, based on somewhat older data. Currently, no alternative dose-response relationship appears more pragmatic or prudent for radiation protection purposes than the linear no-threshold model.


Subject(s)
Radiation Injuries/epidemiology , Radiation Protection , Cardiovascular Diseases/etiology , Humans , Models, Statistical , Neoplasms, Radiation-Induced/epidemiology , Neoplasms, Radiation-Induced/etiology , Neoplasms, Radiation-Induced/prevention & control , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Radiation Protection/methods , Radiation Protection/standards , Radiometry/standards
18.
Radiology ; 248(1): 254-63, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18566177

ABSTRACT

Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.


Subject(s)
Nuclear Medicine/standards , Radiation Dosage , Radiology/standards , Relative Biological Effectiveness , Risk Assessment/standards , Tomography, X-Ray Computed/standards , United States
19.
Semin Nucl Med ; 38(5): 384-91, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18662559

ABSTRACT

Medical radiation exposure of the U.S. population has not been systematically evaluated for almost 25 years. In 1982, the per-capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. The preliminary estimates of the National Council on Radiation Protection and Measurements Scientific Committee 6-2 medical subgroup are that, in 2006, the per-capita dose from all medical exposure (not including radiotherapy) had increased almost 600% to 3.0 mSv and the collective dose had increased more than 700% to approximately 900,000 person-Sv. >Nuclear medicine accounted for only about 2% of all procedures but 26% of the total collective dose from diagnostic studies in medicine. In 1982, the estimated number of nuclear medicine procedures was about 7.5 million. The per-capita effective dose from nuclear medicine was 0.14 mSv and the collective dose was 32,000 person Sv. By 2005, the estimated number of procedures had increased to about 19.6 million. The per-caput effective dose increased to about 0.75 mSv and the collective dose to about 220,000 person Sv. There also has been a marked shift in the type of procedures being performed with cardiac scanning accounting for about 70% of procedures.


Subject(s)
Body Burden , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Nuclear Medicine/statistics & numerical data , Radiometry/statistics & numerical data , Humans , Pilot Projects , United States
20.
Radiat Res ; 189(1): 5-18, 2018 01.
Article in English | MEDLINE | ID: mdl-29136393

ABSTRACT

This commentary summarizes the presentations and discussions from the 2016 Gilbert W. Beebe symposium "30 years after the Chernobyl accident: Current and future studies on radiation health effects." The symposium was hosted by the National Academies of Sciences, Engineering, and Medicine (the National Academies). The symposium focused on the health consequences of the Chernobyl accident, looking retrospectively at what has been learned and prospectively at potential future discoveries using emerging 21st Century research methodologies.


Subject(s)
Chernobyl Nuclear Accident , Radiation Injuries/epidemiology , Humans , Neoplasms, Radiation-Induced/epidemiology , Neoplasms, Radiation-Induced/psychology , Occupational Exposure/adverse effects , Radiation Injuries/psychology , Radiobiology
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